Out of hospital

strategy for Bromley18 November 2015

Dr Angela Bhan

Chief Officer, Bromley CCG

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Why a strategy now?Bromley CCG and London Borough of Bromley have been working with

iMPOWER to help us formulate a new health and care strategy. Amongst

other challenges, we face:

Inequalities in health and longevity

Relatively low level of integration of services

Patchy primary, secondary and tertiary prevention

Rising healthcare demand that will become unaffordable if we do nothing

Excessive focus on short term performance issues, which deflects focus away

from preventive and proactive models of care

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What is the need in Bromley

Diabetes is one of the most prevalent chronic condition in Bromley – about

14,000 people are on GP diabetes registers – over 5% of the population.

Probably twice that number are at high risk of developing diabetes.

Over 5% have asthma and 14% have high blood pressure, over 3% have

coronary heart disease

Over 5% have a moderate or severe physical disability

Nearly 2% of the population have some level of learning disability

1% of the population of Bromley have been identified by general practice as

having serious mental health illness

People with mental health issues or a learning disability have worse levels of

physical health and die younger than expected when compared with the overall

population

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What do we need to do

1. Improve joined up working:

Community services working in a more integrated way with general

practice teams

Better identification of those at risk and care planning for them

Better communication and sharing of information between services

2. Better access to services:

Single point of access to services to help patients

get to the most appropriate services

Produce map/directory of services for staff to help

direct and refer patients to relevant services (incl 3rd sector)

More direct access care for patients to speed up diagnosis and

achieve better outcomes

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What do we need to do

3.Improve the co-ordination of care

Create co-ordinator roles to enable patients to move

seamlessly between services

Shared integrated IT, professionals having access to

patient notes, test results, etc

Co-location of services, to enhance joined up services

and reduce duplication

4.Improve use of resources

The patient themselves, knowledge of own health and self

management, reducing relapses

Better community signposting

Use of volunteers and voluntary organisations to increase

awareness and how to access services

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What do we need to do

5. Deliver more pro-active care

Directory of services for patients and professionals

Advanced care planning

6. Expand care capacity

Increase rapid response services in the community

Improve support for carers, mapping work being done

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ICNs will operate at three levelsThe ICN model in Bromley will be delivered through a borough wide specialist offer and through the provision

of ICN hubs. The following diagram provides illustration of how the ICN model will work in practice.

VOLUNTARY AND COMMUNITY SECTOR

Early discussions are progressing with the VSSN about how

the sector can help deliver the strategy, and how the third

sector can provide additional benefits to the delivery of the

ICNs:

• Having a partnership approach or single contract for all

the VCS activity commissioned as part of the new ICN

model.

• A single representative from the VCS on the appropriate

governance structure for each ICN, taking shared

responsibility for delivery of collective outcomes on behalf

of the VCS.

• Quality and value for money benefits from having the VCS

making a direct contribution to a whole system model of

healthcare.

• Encompassing the ‘patient voice’ and helping people

connect about health and wellbeing issues that are

important to them, their family and their community.

• True integration with all key providers from the third /

voluntary sector.

COMMUNITY PHARMACISTS

It is envisaged that as part of the introduction of the ICN model in Bromley, the CCG and the council will commission

community pharmacists to provide the wider ranging services detailed above in order to make services more accessible

for the population, reduce pressure on the urgent care system, and free up capacity for other health and social care

professionals.

Voluntary and Community services are

fundamental in the delivery of proactive, accessible

and co-ordinated care within the ICN model

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Commissioning the third sector

Clear links with improved outcomes of care

Five Year Forward View

Core to self management and empowerment

Contribution to stronger communities and community resilience

Best placed to provide:

Social prescribing

Peer support

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What is happening in Bromley

Joint commissioning of an asset mapping report -

important commissioning resource

Joint commissioning and development of services

that are core to the pathways of care e.g. building a

vision and strategy for Carers

Development of out of hospital strategy to transform

services aimed at ensuring the best possible

outcomes in a ‘sustainable system’

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Summary

The proportion of older people in Bromley is increasing with the result of an

increase in chronic diseases – there is increasing demand for the local health

and social care economy.

We will need to deliver health and social care differently in the future if we are

to remain ensure sustainable quality services and within budget

Integrated delivery of health and social care can help to address this gap;

however providers, including the third sector, in Bromley are not systematically

working in this way

Summary

We need to increase integration of services outside hospital and

also between hospital and community services

We need to break the cycle of urgency and fire-fighting in which

the health and social care system is less able to invest in

transformation for the longer term, and move to a model which has

greater focus on prevention, proactive management and improved

patient outcomes

We need to maximise use of all partners and stakeholders,

including the third sector and the population itself13

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Any questions?

Thank you